Box 1.

Example of a case reported to the TGA

A 67-year-old Australian woman had been taking clozapine for 1767 days (almost 5 years) at a dose of 400 mg/day. Other regular medication included nifedipine, quinine sulphate, and estrogen ointment. She presented with abdominal distension and fecal impaction. An abdominal X-ray revealed grossly distended bowel and abdominal distension, with gas and feces in the rectum. She was prescribed laxatives (lactulose and docusate with senna). Two days after onset of symptoms, vomiting with aspiration resulted in cardiorespiratory arrest and death. Ref #172621